Spine

Published on 12/06/2015 by admin

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Last modified 12/06/2015

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2

Spine

2.1

Scoliosis

Congenital

Prognosis is dependent on the anatomical abnormality and a classification (see figure on p. 37) is, therefore, important.

image

1. Failure of formation

2. Failure of segmentation

3. Mixed defects

Indicators of serious progression are:

Associated abnormalities may occur – urinary tract (18%), congenital heart disease (7%), undescended scapulae (6%) and diastematomyelia (5%).

Mesodermal and neuroectodermal diseases

1. Neurofibromatosis* – in up to 40% of patients. Classically a sharply angled short segment scoliosis with a severe kyphosis. The apical vertebrae are irregular and wedged with adjacent dysplastic ribs. 25% have a congenital vertebral anomaly.

2. Marfan’s syndrome* – scoliosis in 40–60%. Double structural curves are typical.

3. Homocystinuria* – similar to Marfan’s syndrome.

4. Other skeletal dysplasias – spondyloepiphyseal dysplasia congenita, spondyloepimetaphyseal dysplasia, pseudoachondroplasia, metatropic dwarfism, diastrophic dwarfism, Kniest disease, spondylocostal dysostosis.

Painful scoliosis

1. Osteoid osteoma* – 10% occur in the spine. A lamina or pedicle at the apex of the curve will be sclerotic or overgrown.

2. Osteoblastoma*.

3. Intraspinal tumour (see 2.16).

4. Infection.

2.2

Solitary collapsed vertebra

1. Neoplastic disease

2. Osteoporosis (q.v.) – generalized osteopenia. Coarsened trabecular pattern in adjacent vertebrae due to resorption of secondary trabeculae.

3. Trauma.

4. Infection – with destruction of vertebral end-plates and adjacent disc spaces.

5. Langerhans’ cell histiocytosis* – eosinophil granuloma is the most frequent cause of a solitary vertebra plana in childhood. The posterior elements are usually spared.

6. Benign tumours – haemangioma, giant cell tumour and aneurysmal bone cyst.

7. Paget’s disease* – diagnosis is difficult when a solitary vertebra is involved. Neural arch is affected in most cases. Sclerosis and expansion. If other non-collapsed vertebrae are affected then diagnosis becomes much easier.

2.3

Multiple collapsed vertebrae

1. Osteoporosis (q.v.).

2. Neoplastic disease – wedge fractures are particularly related to osteolytic metastases and osteolytic marrow tumours, e.g. multiple myeloma, leukaemia and lymphoma. Altered or obliterated normal trabeculae. Disc spaces are usually preserved until late. Paravertebral soft-tissue mass is more common in myeloma than metastases.

3. Trauma – discontinuity of trabeculae, sclerosis of the fracture line due to compressed and overlapped trabeculae. Disc space usually preserved. The lower cervical, lower dorsal and upper lumbar spine are most commonly affected. Usually no soft-tissue mass. MRI usually shows the end-plates to be spared, cf. pyogenic infection.

4. Scheuermann’s disease – irregular end-plates and numerous Schmorl’s nodes in the thoracic spine of children and young adults. Disc-space narrowing. Often progresses to a severe kyphosis. Secondary degenerative changes later.

5. Infection – destruction of end-plates adjacent to a destroyed disc.

6. Langerhans’ cell histiocytosis* – the spine is more frequently involved in eosinophilic granuloma and Hand–Schüller–Christian disease than in Letterer–Siwe disease. Most common in young people. The thoracic and lumbosacral spine are the usual sites of disease. Disc spaces are preserved.

7. Sickle-cell anaemia* – characteristic step-like depression in the central part of the end-plate.

2.4

Erosion, destruction or absence of a pedicle

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